I am in a bit of a condition of excitement, or perhaps a better word is urgency, which without a doubt has developed (or the propensity for it has) over the months I have been on the lower dosage of Risperdal instead of the higher dosage (in fact the dosage I was on was the middle one of three available dosages, and I am now on the lowest). One major point I wish to make is that this condition - an elevated turnover of dopamine, doubtless - has taken many months to work itself up and does not correspond hour by hour (or even day by day) with the reduction in Risperdal in the metabolism. I presume the condition has come about through some sort of slowly effective positive feedback by which the dopamine turnover has ratcheted up. One alternative hypothesis is that it has come about so slowly because it depends on changes in the synapses, that is synapses altering in the sort of way they do when memory traces are laid down, to gradually allow more transmission of dopamine. I believe there is evidence that people on dopamine-blocking drugs over an extended period develop some slight tolerance, as the synapses adapt and allow more dopamine through despite the dopamine blockade. So one would guess the number of receptor sites in the target plate increases as some of the existing ones are rendered ineffective by being blocked constantly. (Of course the trouble with that theory is it might lead one to expect the opposite on withdrawal or reduction of a dopamine-blocker, that is for the number of receptor sites to decline as a greater proportion of them become effective.)
I did not get a lot of sleep last night. I slept from about 8 pm to about midnight, and this is a feature I have in my nature, to get sleepy early but also to wake up early and what one would have to call disproportionately early many mornings. I have been logged into Twitter most of the hours since midnight, and I was finding that slight stimulation (which you can understand mostly disconnected fragments such as get through from Twitter provide) was capturing my interest and keeping me 'on the hook'. However, the interest I find in explaining myself here was enough - the foreseen interest, that is - to persuade me to turn Twitter off and start writing down my experience and my interpretation of it.
I have to say some nights I do catch up on my sleep and the following day feel refreshed and able to cope easily with any stimulation I need to process for. I suppose it strengthens what I think of as the positive feedback if I am tired (not having had enough dreaming sleep to post-process during the night) so that in the daytime I rush at things without adequately preparing. Deliberately removing stimulation (turning Twitter off) and taking time over what needs to be done surely is a method which despite the electrochemistry of the brain (versus the pharmacology) will improve matters. To be honest, that's one thing which hospitalisation has always provided - even before effective drug treatments - that is removal of factors needing processing in a version of a holiday, hopefully to interrupt the positive feedback loop. That was the ideal of hospitalisation, although on first arriving at the hospital finding a weird and unlearned milieu (and quite possibly unanticipated, if the patient was Sectioned) would worsen symptoms by giving more to process on.
As regards my situation today - I mean today Monday - while I was on Twitter I was not planning what I need to do, to make sure I cope efficiently and effectively; and I am not even planning adequately now, as I am writing this. If I had had more sleep (to show up with more exemplary detail how it would work) I would be doing the planning at the same time as doing other 'processing', on Twitter or composing what I am writing. Without adequate planning I will rush from place to place, from activity to activity, and tire myself out more than need be, and worsen the 'positive feedback' cycle of having to cope with more and more but having fewer and fewer resources (especially if I keep missing sleep).
What I actually need to do today is fairly simple, when thought through explicitly, and certainly is less taxing than if I were in a position where I needed to go to work and also cater for my home life. I need to go shopping, and the only slight complication is I need to go to two different towns, and what I call planning for efficiency and effectiveness comes down (to a large degree) to going to the towns in the right order, and (I suppose) at the right times. I am better off, in some ways, with spending my time writing this, as it is not actually costing me much physically - in terms of energy or money - and at least it is related at one remove to the genuine planning I would be well to engage in.
When I was awake in the night - possibly this was caused by the numerousness of the distinct stimulations on Twitter (separate Tweets, put simply), or more likely by less time having passed since the physical stimulations of yesterday at home (even if the additional passing time has not seen me sleep a lot of the hours) - I was feeling active and as though I might go out very early (say as soon as buses started running) which would have been a cost in money (because my Concessionary Bus Pass is not valid before 9.30 am) and a cost in worsening positive feedback from exposing myself necessarily to more stimulation out and about. (Incidentally, readers will see that getting into that sort of cycle is the very antithesis of leading the empty worthless life I lead on too high a dosage of medication.)
I think all I have to add now - before thinking more thoroughly about what time to go out and where to go first - is that mentioning 'physical stimulations at home' I had in mind the fullness of the house this week, my grandchildren (step-grandchildren, anyway) having come to visit their mother who with her dog is herself a semi-permanent fixture in our home now. What I mean is, my elevated level of mental activity, which risks turning into an elevated level of physical activity and elevated in the sense of variety requiring processing (not going for a brisk walk every day on a regular route at a regular time, which might be a beneficial increase in activity), could well have come about substantially because there are more people now in my day-to-day life, and they are more boisterous people.
No comments:
Post a Comment